{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"P SALGUODNOSRETTA","gend":0,"add":"HBULC 0433DAOR ESUO","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"1965-02-05","age":"","mstatus":"","insh":"28300210*89","cliId":"","pno":"09\/7576891-7","cno":"757\/201-0737","email":"","ename":"","eno":"","pphy":"AUSTIN, WARREN E MD","ppno":"757\/689-8430","pcpadd":"1925 GLENN MITCHELL DRIVE STE 100","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23456,"pcpcounty":"","pcpid":"","pcpname":"Princess Anne Medical Associates","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M16.12","Z47.1","Z96.642","Z79.82","R07.89","F14.10","S90.121S","S93.509A","Z00.00","F17.200","Z12.2","Z23.","R73.02","I10.","E55.9","S29.011A","Z96.643","M62.81","M16.11","R07.9","M25.551","G56.00","Z30.2","M70.61","M25.552","M77.41","M77.42","M79.672","M79.671","M20.41","M20.42","M79.605","Z96.641","Z01.810","Z01.818","Z98.84","F17.210","E66.9","Z68.34","S90.121A","S93.504A","Z96.649","Z01.812","R94.31","R26.89","I51.7"],"date":["2019-11-12","2021-12-30","2021-11-19","2019-09-10","2019-10-14","2019-10-14","2020-02-19","2020-02-19","2021-05-10","2021-05-10","2021-05-10","2021-07-21","2020-06-26","2021-12-09","2020-06-26","2021-03-24","2021-12-30","2021-12-30","2021-12-28","2019-10-14","2021-12-14","2019-09-04","2019-09-04","2021-09-20","2020-09-16","2021-08-09","2021-08-09","2021-08-09","2021-08-09","2021-08-09","2021-08-09","2019-10-14","2021-11-19","2021-10-07","2019-08-19","2019-09-03","2019-09-04","2019-09-04","2019-09-03","2020-02-19","2020-02-19","2021-11-17","2021-10-07","2021-10-07","2021-11-17","2019-10-14"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","","CELECOXIB"," CELECOXIB ","30","Select","Select",""],["","","PROMETHAZINE"," PROMETHAZINE ","10","Select","Select",""],["","","ASPIRIN"," ASPIRIN ","60","Select","Select",""],["","","OXYCODONE"," OXYCODONE ","42","Select","Select",""],["","","IBUPROFEN"," IBUPROFEN ","20","Select","Select",""],["","","HYDROCO\/APAP"," HYDROCO\/APAP ","4","Select","Select",""],["","","AFLURIA"," AFLURIA ","0","Select","Select",""],["","","STOOL"," STOOL ","60","Select","Select",""],["","","FLUARIX","INJ 2020-21","","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}